URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.
INSERM 970, Équipe 2, PARCC, HEGP, Paris, France.
Obes Surg. 2019 Sep;29(9):2814-2823. doi: 10.1007/s11695-019-03912-6.
Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG.
Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017.
A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula's termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage.
Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.
胃瘘是袖状胃切除术（SG）后的一种严重并发症。慢性胃瘘可发展为复杂的解剖情况，如食管胃-支气管和/或食管胃-胸膜（EGBP）瘘。我们决定分析 SG 后这些 EGBP 瘘的解剖特征。
我们的工作包括分析 2009 年 5 月至 2017 年 11 月在乔治·蓬皮杜欧洲医院接受 EGBP 瘘治疗的患者的临床、内镜和影像学资料。
共回顾性纳入 11 例有完整临床、内镜和影像学资料的患者。瘘管的起源大多位于吻合线的顶部。瘘管的终点在 5 例患者（45%）为胸膜，在 6 例患者（55%）为支气管。在支气管瘘中，近端 2 例，远端 4 例，左肺后外侧段（S10）均有到达。11 例患者中有 9 例（82%）经横膈膜穿过左穹窿，2 例（18%）穿过横膈膜。有趣的是，2 例食管支气管瘘经横膈膜穿过，支气管近端终止，而 4 例胃支气管瘘经横膈膜穿过，支气管远端终止。所有胸膜瘘均为胃瘘，经横膈膜穿过。
SG 后食管胃-支气管和胃-胸膜瘘主要起源于吻合线的顶部。食管支气管瘘经横膈膜穿过，支气管近端终止，而胃支气管瘘经横膈膜穿过，支气管远端终止。
